Doctor Answers 7

Breast Reduction

May 3rd, 2011

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If you have back pain, shoulder grooving, large breasts for your height and weight, have tried conservative therapies (wide strapped bras, over-the-counter medication, etc) and have had no relief, you may be a candidate for a breast reduction. You should contact your insurance provider to determine if this is a benefit covered under your specific plan. The next step would be to have a consultation appointment with a board certified plastic surgeon. Upon examination, your surgeon would be able to determine if you are a good candidate for a breast reduction. Your reputable physician's office will be able to assist you with your insurance pre-certification. Breast reduction can make a tremendous difference in your quality of life. Best wishes!!!

Breast Reduction Candidate?

Based on your description you may be an excellent candidate for breast reduction surgery. It is one of the most patient pleasing operations were performed. The procedure, however is never “mandatory”.

The best way to obtain insurance coverage for breast reduction surgery obtaining documentation of your symptoms from as many healthcare practitioners as possible. For example your primary care doctor, physical therapist, chiropractor etc. can document the effect is large breasts have on your well-being; this documentation will be helpful when it comes to obtaining insurance “authorization” for the procedure.

It would behoove you to seek consultation with a well experienced board-certified plastic surgeon.

Breast Reduction - Wearing 2 or 3 Bras at One Time: Is Surgery Optional or Mandatory?

June 17th, 2011

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Hi Nashville712,

Mandatory? Probably not. Beneficial - Very Well Might Be.

You're wearing 2-3 bras so I'll assume that you have large breasts for your frame - but that is, in fact, the first issue: how large are your breasts? If you have primarily sagging (nothing personal) then you may benefit from the surgery but you're unlikely to get insurance coverage for it. If you're large enough, then you may be able to get insurance coverage.

There are many issues with respect to insurance (you can always pay for the surgery on your own, but that may not be necessary. Or desirable!). Each insurance company is different, and each has its own rules with respect to "coverage." You'll first have to contact your company to make sure it's covered, and then you have to find a surgeon who will accept the payment the insurance company says is "usual and customary." That may or may not be easy to do. If you start with the surgeons who participate in the insurance company you'll be off to a good start. If you'd rather use a different surgeon, and you have out-of-network benefits, you can contact the surgeon's office and see if he/she will accept that payment.

Either way, you'll need the help of a plastic surgeon to submit a letter of precertification and photos and to make sure that everything is set before you have the surgery. You should, of course, meet with a few plastic surgeons to see what they recommend, and make sure you're informed about the procedure and its risks so that you can proceed knowledgeably. If you do all of this you'll be most likely to have a result you'll be happy and comfortable with.

Breast Reduction Pictures

Wearing 2 or 3 Bras at One Time: Is Surgery Optional ?

April 28th, 2011

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A few definitions:
ELECTIVE Surgery = the opposite of EMERGENCY surgery; surgery in which the surgeons chooses WHEN to operate because life and function are not threatened. Elective surgery can be Functional (repairing or restoring function = most insurance based surgery) OR Cosmetic - surgery intended to only improve appearance.

From your description, your breasts may be large enough in which they MAY impact your function and MAY be covered by your insurance policy. This does not mean that they are covered. Each policy is in effect an individual contract; some policies have Breast Reduction benefits while others do not. If your policy does not have such benefits the operation will not be covered and you will have to pay for it out of pocket.

If you are thinking of buying a policy now you should be aware that most policies have pre-existing condition clauses that may require you to wait a year before they cover such conditions. Read carefully.

Breast reduction insurance coverage.

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2) Very big reductions (like from an F cup to a C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

Breast reduction as a covered benefit

April 28th, 2011

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Mandatory is not a word used by the insurance industry when it comes to breast reduction and what you should look for in an insurance plan is breast reduction as a covered benefit. Many now refuse coverage, or exclude coverage no matter what kind of complaints you have, or how much breast reduction will improve your life. Even if breast reduction might be covered, there may be a long list of excluding factors which would deny benefits, such as the ability to wear several bras to reduce symptoms instead of surgery. Shop carefully and ask questions.

Back pain may be a reason to consider breast reduction

April 28th, 2011

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If you are experiencing back pain and have large breasts you may be a candidate for breast reduction which could be covered by your health insurance. I recommend consulting with a plastic surgeon to review your options and determine if you have enough breast tissue to be eligible for this procedure under insurance.

The results are fairly dramatic and your neck/back pain could go away immediately with this surgery.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.